潰瘍性大腸炎の残存直腸に発生したdysplasiaの1例

Dysplasia of the Rectum, Following Colectomy and Ileorectal Anastomosis in Long Standing Ulcerative Colitis, Report of a Case

要旨　潰瘍性大腸炎の結腸全摘，回腸直腸吻合術後，残存直腸にdysplasiaの発生した1例を経験した．患者は62歳の女性，全結腸炎型で，発症後14年で上記手術を行い，緩解を維持していたが，発症後29年して残存直腸に広範な，丈の低い隆起性病変を認めた．この病変は周囲との境界が不明瞭，表面は凹凸不整で，一部にポリープ様突出があり，ポリベクトミーおよび多数の生検によってRiddellらの述べるlow grade dysplasiaと判定した．周囲の直腸粘膜は緩解期の像を示した．潰瘍性大腸炎術後の残存直腸に発生した癌，dysplasiaの報告は本例も含めて本邦では3例であるが，経過年数と共に増加する可能性があり，定期的内視鏡検査によるdysplasiaの早期発見が重要である．

　A 62 year-old woman with total colitis was operated 14 years after the onset. She had been in a state of remission for the next 15 years when a broad polypoid lesion was detected. Multiple biopsy specimens revealed low grade dysplasia (according to the definition of Riddell), and the surrounding rectal mucosa showed mild inflammation.

　In Japan, there have been reported only 3 cases, including our case, with dysplasia or cancer in the part of the rectum remaining after colectomy for ulcerative colitis. The importance of periodic colonoscopy (to detect dysplasia in the rectum following colectomy) was emphasized.